You have already heard that the best way to prevent cardiovascular disease including heart attack, atherosclerosis (i.e. hardening of the arteries), high blood pressure and stroke is with a healthy lifestyle. We all know that we should eat healthy foods, exercise, avoid tobacco and manage our weight. For many people this lifestyle is too difficult or not sufficiently effective due to genetics, so physicians recommend prescription drugs.
Antihypertensive drugs are usually effective in reducing blood pressure. Statin drugs lower LDL and total cholesterol. While effective, these drugs can unfortunately come with serious long term side effects.
Recent research shows that there are additional prescription and natural ways to improve your cardiovascular health. My goal is to help you understand the various treatment options and how they work so that you can discuss these options with your physician.
Understanding the chemistry:
Blood plasma is 92% water. Since water and oil don't mix, in order to transport fat in the bloodstream from the liver to body tissues, fats must be bound to lipoproteins. The two main forms of fat transported in the bloodstream by these lipoproteins are triglycerides and cholesterol.
Two of the predominant lipoprotein particles are LDL (low density lipoprotein) and HDL (high density lipoprotein). The cholesterol attached to LDL is often referred to as "bad cholesterol," because these small particles can deposit behind blood vessel walls and cause atherosclerosis (hardening of the arteries). HDL cholesterol is called "good cholesterol" because the HDL transports cholesterol back to the liver, where the body can eliminate it.
However, these good and bad classifications are misleading because both LDL and HDL can be either beneficial or harmful, depending on particle size, oxidation, and other factors. (Refer back to our previous blog articles on NMR lipid tests for particle size and number).
You may not realize it, but food is not the only source of cholesterol. Your liver makes it too. That is why diet alone is often not the full solution. Statins work because they inhibit an enzyme involved in making cholesterol in the liver and boost the number of LDL receptors to help clear the body of LDL cholesterol. But, like all prescription drugs, they have adverse side affects.
There is also a new class of injectable drugs approved in 2015 known as PCSK9 inhibitors that have been shown to dramatically lower LDL cholesterol by up to 60% when combined with a statin. These drugs are monoclonal antibodies, which is a type of biologic drug which binds to and inactivates a protein in the liver. So, by inactivating PCSK9, more receptors are available to capture LDL to be broken down and removed from the blood. However, they are very expensive and also come with serious side effects, so they are reserved for severe cases.
Treatment alternatives to statins are important because about 1 in 5 patients on statins cannot lower their cholesterol adequately. Additionally, some patients stop or don't wish to use statins due to side effects. Statins also cause the depletion of the body's natural CoQ10. CoQ10 is so vital that virtually everyone taking a statin should be taking supplemental CoQ10!
Lifestyle and Natural Treatment Options:
These are some approaches you may wish to take in addition to or, in some cases, instead of statins. Always consult with your doctor first if you are being treated for cardiovascular disease.
- Include sufficient Omega-3 fats like nuts, avocado, cold-water fish as well as consuming foods high in soluble fiber. Also include a variety of spices like basil, rosemary and tumeric. Consuming even healthy fats may seem counter-intuitive, but if you avoid all fats, your liver will compensate because fats are necessary for making hormones and are also vital to brain health.
- Avoid or limit sugar, alcohol and refined carbohydrates which stimulate the liver to produce more cholesterol and increase inflammation.
- Avoid hydrogenated and trans fats which are pro-inflammatory and increase cholesterol.
- Fish Oil (1000-2000mg daily). Recommendations include Orthomega-820 or EPA/DHA Essentials from Pure Encapsulations. Not all fish oils are created equal. It is important to take only high quality fish oils that do not contain mercury or other contaminants.
- CoQ10 (200-300mg daily) - Especially important if you are on cholesterol lowering medications as they deplete levels of this important enzyme. Ortho-Molecular, Pure Encapsulations and Megagenics all have very good products.
- Niacin (50 to 500mg daily) - Start at a low dose and work up to avoid the discomfort of flushing. It should be avoided by anyone with liver disease.
- Red Yeast Rice (1200mg two times daily) - Works well but has some of the same side effects as statins including depletion of CoQ10.
- Kyolic Reserve Aged Garlic (600-1200mg daily) - I especially like this product at 600mg twice daily. This product has been well studied and offers many cardiovascular health benefits. I generally recommend this product for everyone over 40 due to the many health benefits.
- Bergamot BPF - This is my favorite go-to product for a natural approach to cholesterol management. This is a Bergamot Polyphenolic product that has been well studied. (You can find a full review of this product on the website).
Whether you choose prescription medications or natural supplements to manage cholesterol, it is important to incorporate a healthy lifestyle and good dietary choices for successful results.
To your health!
Mike Woodley, R.Ph.,FAARM
Chief Health Officer